OBJECTIVE. Theaimof thisstudywastoassess therolesof transrectal colorDoppler andgray-scale sonography in revealing prostatic cancer,using biopsy as the referencestandard. SUBJECTSAND METHODS. Twohundred fifty-sixpatients referred forurologic studies underwent transrectal sonography using gray-scale and color Doppler scanning. All abnor mal areas shown on gray-scale or color Doppler sonography or both were targeted and biopsies were performed. The patients also underwent random sextant biopsies. All biopsies were mdi viduallycorrelatedwith histopathologic findingsandall resultswereanalyzed. RESULTS.Cancer wasfoundonbiopsyin 100patients (39%),andequivocal sonographicresults or prostatic intraepithelial neoplasia was found in 22 other patients (9%). In 16 of the patients in whom cancer was detected, the tumors were correctly revealed only with color Dop pIer sonography.These 16patients had a meanGleason scoreof 6.4 (range, 5â€"8). Biopsy find ings in these 16 patients showed eight patients with extensive lesions, three with moderate lesions, and five with minimal lesions. However, in nine other patients with cancer (9% of can cers detected), both gray-scale and color Doppler sonography failed to reveal lesions that were found on sextant biopsy. An analysis showed that, although highly sensitive, color Doppler sonography wassomewhatlessspecificthangray-scalesonography. CONCLUSION. ColorDopplersonography should become a routinepartof transrectalsonography of theprostateglandto improvedetectionandtargetingoflesions.The practiceof performing random sextant biopsies should also continue. P rostatic cancer is the most common malignancy in the American male population. Although widely ac ceptedand usedin the diagnosisof prostatic cancer, transrectal sonography has limitations.Prostaticcarcinomasmay be isoechoicI 1] and consequently not visualized on gray-scale sonography. Conversely, the most common sonographic appearance for prostate carci nomaâ€"theperipheral zone hypoechoic le sionâ€"canalso, on histopathologic examination of biopsy specimens, be found to represent a be nign lesion [2, 31.Limitations such as these may be partly over come by advances in technique. Several reports To evaluate the role of color Doppler transrectal sonography in detecting prostatic cancer in referred urologic patients, we pro spectively compared its usefulness with that of gray-scale imaging (keeping in mind the role of sextant biopsies) and correlated the results with biopsy findings. Subjects and MethodsThe population in this study consisted of 256 consecutive patients referred by urologists during theperiodbetween April andSeptember 1996. The patientswere40â€"84 yearsold (meanage,64years). Forty-threepatients(17%) were referredbecauseof an abnormality found on digital rectal examination, I 17 (46%) because of a raised (or rising) level of prostate-specific antigen (PSA), 90 (35%) because of botha raisedlevelof PSAandanabnormality on
Facial appearance is largely determined by the morphology of the underlying skeleton. Hydroxyapatite is one of several materials available to enhance projection of the facial skeleton. This study evaluated the long-term maintenance of augmented bony projection when porous hydroxyapatite granules are used on the facial skeleton. Ten female patients aged 28–58 years were studied following aesthetic augmentation of the facial skeleton at 24 sites using porous hydroxyapatite granules. Postoperative CT scans at 3 months served as the baseline measurement and compared with scans taken at 1 and 2 years, with the thickness of the hydroxyapatite measured in axial and coronal planes. Thickness of original bone plus overlay of hydroxyapatite, thickness of the overlying soft tissue, and the overall projection (bone plus soft tissue) were recorded. It was found that 99.7% of the hydroxyapatite was maintained at 2 years, with no statistical difference (t test) from the baseline measurement. The overall projection (bony and soft tissue) was maintained as there was no evidence of native bone resorption or soft tissue atrophy. Radiographic results confirmed that the use of porous hydroxyapatite granules for enhancement of the facial skeleton is not only a predictable procedure, but maintains full bony projection at 2 years.
The Nutcracker Syndrome, caused by compression of the left renal vein as it passes in a tight angle between the aorta and the superior mesenteric artery, usually presents with unexplained haematuria localized to the left ureteric orifice. We report on a series of cases where compression of the left renal vein caused prominent left-gonadal-vein reflux, which in turn resulted in lower-limb varices and varicocele formation.
Considerable advances have occurred in the sonographic imaging of small parts over recent years, including improved transducer technology and Doppler imaging. After reviewing briefly prostatic anatomy, including McNeal's concept of zonal anatomy, the techniques used for examining the prostate gland sonographically and for performing biopsy are discussed. Ultrasound (US) findings in the normal gland, in benign prostatic hyperplasia, and in prostatic cancer are described, with an emphasis on cancer. The role of targeted and random biopsy is assessed, as is the role of color Doppler in detecting prostatic cancer. An overview of the findings in inflammation and infertility also is provided. The technique used for examining the scrotum and testicles is discussed after a short review of scrotal anatomy. The sonographic appearances of the normal scrotal contents are described, followed by a discussion of findings in tumors, inflammatory conditions, and testicular torsion. A synopsis of the appearances of cysts and microlithiasis also is provided. Both the increased use and expectations by surgeons of US in the assessment of the prostate and testicles make it imperative to understand the techniques, range of findings, new developments, and limitations involved in using this modality.
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